Secondary Prevention of Cardiovascular Disease in Patients With Type 2 Diabetes Mellitus International Insights From the TECOS Trial (Trial Evaluating Cardiovascular Outcomes With Sitagliptin)
Secondary Prevention of Cardiovascular Disease in Patients With Type 2 Diabetes Mellitus International Insights From the TECOS Trial (Trial Evaluating Cardiovascular Outcomes With Sitagliptin)
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DOI：
10.1161/circulationaha.117.027252
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发表时间：
2017-09-26
期刊：
影响因子：
37.8
通讯作者：
Peterson, Eric D.
中科院分区：
文献类型：
--
作者：
Pagidipati, Neha J.;Navar, Ann Marie;Peterson, Eric D.
背景：强化危险因素修正显著改善糖尿病和心血管疾病患者的结局。然而，在国际临床实践中二级预防治疗目标的实现程度尚不清楚。达到5项二级预防参数-阿司匹林使用、血脂控制（低密度脂蛋白胆固醇< 70 mg/dL或他汀类药物治疗），血压控制（收缩压< 140 mm Hg，舒张压< 90 mm Hg），使用血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂，在38个国家的13616例糖尿病患者和已知心血管疾病患者中评估了西格列汀治疗的心血管结局（试验）。Logistic回归分析用于评估个体和区域因素与基线二级预防成就之间的相关性。考克斯比例风险回归分析被用来确定基线二级预防成就和心血管死亡，心肌梗死，或stroke.RESULTS：总体而言，29.9%的糖尿病和心血管疾病患者在基线达到所有5个二级预防参数，虽然71.8%达到至少4个参数之间的关联。北美的比例最高（41.2%），而西欧、东欧和拉丁美洲的比例约为25%。就个人而言，血压控制（57.9%）的总体成就最低，而非吸烟状态最高（89%）。在中位3.0年的随访中，较高的基线二级预防评分与逐步分级关系中的结局改善相关（校正风险比为0.60; 95%置信区间为0.47-0.77，对于那些实现所有5项指标的患者，
BACKGROUND: Intensive risk factor modification significantly improves outcomes for patients with diabetes mellitus and cardiovascular disease. However, the degree to which secondary prevention treatment goals are achieved in international clinical practice is unknown.METHODS: Attainment of 5 secondary prevention parameters-aspirin use, lipid control (low-density lipoprotein cholesterol < 70 mg/dL or statin therapy), blood pressure control (< 140 mm Hg systolic, < 90 mm Hg diastolic), angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use, and nonsmoking status-was evaluated among 13 616 patients from 38 countries with diabetes mellitus and known cardiovascular disease at entry into TECOS (Trial Evaluating Cardiovascular Outcomes With Sitagliptin). Logistic regression was used to evaluate the association between individual and regional factors and secondary prevention achievement at baseline. Cox proportional hazards regression analysis was used to determine the association between baseline secondary prevention achievement and cardiovascular death, myocardial infarction, or stroke.RESULTS: Overall, 29.9% of patients with diabetes mellitus and cardiovascular disease achieved all 5 secondary prevention parameters at baseline, although 71.8% achieved at least 4 parameters. North America had the highest proportion (41.2%), whereas Western Europe, Eastern Europe, and Latin America had proportions of approximate to 25%. Individually, blood pressure control (57.9%) had the lowest overall attainment, whereas nonsmoking status had the highest (89%). Over a median 3.0 years of follow-up, a higher baseline secondary prevention score was associated with improved outcomes in a step-wise graded relationship (adjusted hazard ratio, 0.60; 95% confidence interval, 0.47-0.77 for those patients achieving all 5 measures versus those achieving